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Purpose of Review: The aim of this study is to discuss the symptoms, diagnosis, and management of the neurologic complications of acute and chronic otitis media., Recent Findings: Antibiotic therapy has greatly reduced the frequency of complications of otitis media. However, it is of vital importance to remain aware of the possible development of neurologic complications. There is a trend toward less severe presenting symptoms including otorrhea, headache, nausea, and fever, with altered mental status and focal neurologic deficits presenting later. In order to reduce morbidity, early deployment of a multidisciplinary approach with prompt imaging and laboratory studies is imperative to guide appropriate management. Complications of acute and chronic otitis media may present with neurologic signs and symptoms. It is important to recognize the possible otitic origin of such complications to ensure proper management and to decrease overall morbidity and mortality.

Importance: This study represents up-to-date information on the current status of and future projections for the pediatric otolaryngology workforce., Objective: To provide an update on the practice patterns of and projections for the US pediatric otolaryngology workforce., Design, Setting, and Participants: An online survey was sent to all 172 members of the American Academy of Pediatrics Section on Otolaryngology-Head and Neck Surgery and fielded from May 29, 2014, to September 17, 2014., Main Outcomes and Measures: Current status of and perceived trends in the pediatric otolaryngology workforce., Results: Eighty-four (48.8%) of the 172 members responded to the survey. Not all respondents answered all questions, and so totals and percentages might not reflect a total of 84 for any given response. The demographics and practice characteristics of the responding pediatric otolaryngologists were similar to those noted in a 1997 workforce survey. Fifty-four percent of respondents (n = 38) planned to continue full-time work over the next 5 years, and 47% (n = 31) believed that the number of patients in their practice was increasing. The proportion of those who believed that the need for pediatric otolaryngologists in their community was increasing (31%; n = 21) or decreasing (13%; n = 9) remained relatively constant from the 1997 survey (34% and 12%, respectively). Forty-nine percent (n = 35) reported believing that the number of pediatric otolaryngologists being trained was appropriate and that the need in their community was stable. Eighty-three percent (n = 55) reported believing that employment opportunities for pediatric otolaryngologists in the United States would be plentiful in the near future., Conclusions and Relevance: The overall state of the pediatric otolaryngology workforce appears stable. The perceived current and future needs for pediatric otolaryngologists appear to be met by the current number of trainees. Employment opportunities appear promising for future pediatric otolaryngologists based on our respondents' opinions. This represents up-to-date information on the current status of and future projections for the pediatric otolaryngology workforce.

This case report demonstrates the otologic complications of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN). A five year-old male was admitted to the burn unit with the diagnosis of SJS/TEN believed secondary to acetaminophen use. After resolution of the acute phase, the patient was left with a severe auricular deformity with scarring and complete occlusion of the right external auditory canal (EAC). The patient underwent meatoplasty, canaloplasty, and tympanoplasty with subsequent placement of a molded stent in order to maintain patency of his EAC. Four years later, the patient has a patent right EAC with adequate hearing., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To review pediatric cases of IgA nephropathy (IgAN) in 6 patients who underwent tonsillectomy and had marked improvement of their renal symptoms and to review the appropriate indications for tonsillectomy for this disease., Design: Retrospective case series., Setting: Academic medical center., Patients: Six children (age range, 8-15 years) with renal biopsy-proved IgAN who were referred by a pediatric nephrologist for recurrent tonsillitis., Intervention: Tonsillectomy., Main Outcome Measures: Resolution of clinical features of IgAN, including proteinuria, gross and microscopic hematuria, and stabilization of renal function., Results: The 6 patients in this series had marked clinical and laboratory improvement of their nephropathy., Conclusions: In a select group of pediatric cases of IgAN with mild to moderate disease and recurrent tonsillitis, tonsillectomy can be a useful adjuvant treatment to improve urinary symptoms and renal function. IgA nephropathy is a common indication for tonsillectomy in Japan but is seen less often in the United States. Otolaryngologists should be aware of this indication for tonsillectomy.

Purpose of Review: Drooling is the involuntary spillage of saliva from the mouth. It is a major morbidity associated with cerebral palsy and other neurodegenerative disorders. The consequences of drooling are not restricted to medical issues but can cause major social handicaps. Severe psycho-social consequences, such as social stigmatization and emotional devastation for the patients and their families, may result. This paper reviews recent developments in the management of drooling., Recent Findings: Recent publications report encouraging results with botulinum toxin A. Several surgeons report on their long-term results. Reviews analyze anticholinergic drugs, surgical options, biofeedback, behavioral and speech therapy, and a multidisciplinary team approach., Summary: A team approach is the key to successful rehabilitation. Oromotor therapy is the most useful nonsurgical option. Drugs are unsuitable for long-term use due to adverse effects causing serious medical complications or noncompliance. Botulinum toxin A injection is promising, but no data exists on optimal dosage, duration of action and frequency of repeat injections. Bilateral submandibular duct relocation with bilateral sublingual gland excision has been shown to be effective and safe in long-term follow-up of the largest series of patients. At present, it is the best available surgical option.

Fetus in fetu is a condition in which there is a monozygotic diamniotic fetus encased within the body of its larger more developed twin. We report a case of airway obstruction in a full-term fetus caused by fetus in fetu. Prenatal ultrasound revealed a large cervical mass compressing the neonate's trachea and esophagus. The Ex Utero Intrapartum Treatment procedure was utilized to secure the fetus's airway. Upon resection, a fetiform structure, covered by skin with vertebral tissue and two appendages was appreciated. To our knowledge, this is the first reported case of cervical fetus in fetu in the literature.

Unlabelled: In this prospective, randomized, double-blinded, placebo-controlled study, we compared the incidence of emesis and 48-h recovery profiles after a single dose of preoperative ondansetron versus dolasetron in dexamethasone-pretreated children undergoing ambulatory tonsillectomy. One-hundred-forty-nine children, 2-12 yr old, ASA physical status I and II, completed the study. All children received standardized perioperative care, including premedication, surgical and anesthetic techniques, IV fluids, analgesics, and rescue antiemetic medications. Patients were randomized to receive ondansetron 0.15 mg/kg, maximum 4 mg (Group 1); dolasetron 0.5 mg/kg, maximum 25 mg (Group 2); or saline placebo (Group 3) IV before the initiation of surgery. In addition, all patients received dexamethasone 1 mg/kg (maximum 25 mg). Rescue antiemetics were administered for two or more episodes of retching/vomiting. The incidence of retching/vomiting before home discharge did not differ between the ondansetron and dolasetron groups and was significantly less frequent compared with the placebo group (10%, Group 1; 8%, Group 2; 30%, Group 3). Similar results were obtained at 24-48 h after discharge (6%, Groups 1 and 2; 18%, Group 3). The need for rescue antiemetics administered after the second retching/vomiting episode was significantly less in Groups 1 (4%) and 2 (6%) compared with Group 3 (22%) before home discharge. The complete response rate, defined as no retching/vomiting and no antiemetic for 48 h, was significantly increased in Groups 1 (76%) and 2 (74%) compared with Group 3 (44%). The antiemetic efficacy of prophylactic ondansetron and dolasetron was comparable in dexamethasone-pretreated children undergoing ambulatory tonsillectomy., Implications: The efficacy of a single dose of prophylactic ondansetron versus dolasetron in conjunction with dexamethasone was studied on posttonsillectomy retching/vomiting and 48-h recovery in children 2-12 yr old. Compared with placebo, ondansetron and dolasetron produced comparable reductions in the incidence of retching/vomiting and the need for rescue antiemetics.

We report a case of a newborn female with an unusual suprasternal simple cystic mass found to be a dermoid cyst. Dermoid cysts of the head and neck are rare lesions, but a midline location is characteristic for these congenital masses. A dermoid cyst should be high on the list of differential diagnoses given a unilocular midline cyst in a neonate even if no fat elements are demonstrated on imaging studies.

Unlabelled: In this prospective, randomized, double-blind, placebo-controlled study, we examined the effect of preoperative dexamethasone on postoperative nausea and vomiting (PONV) and 24-h recovery in children undergoing tonsillectomy. One hundred thirty children, 2-12 yr of age, ASA physical status I or II, completed the study. All children received oral midazolam 0.5-0.6 mg/kg preoperatively. Anesthesia was induced with halothane and nitrous oxide in 60% oxygen and maintained with nitrous oxide and isoflurane. Intubation was facilitated by mivacurium 0.2 mg/kg. Each child received fentanyl 1 microgram/kg i.v. before initiation of surgery, as well as dexamethasone 1 mg/kg (maximal dose 25 mg) (steroid group) or an equal volume of saline (control group). Intraoperative fluids were standardized to 25-30 mL/kg lactated Ringer's solution. All tonsillectomies were performed under the supervision of one attending surgeon using an electrodissection technique. Postoperatively, fentanyl and acetaminophen with codeine elixir were administered as needed for pain. Rescue antiemetics were administered when a child experienced two episodes of retching and/or vomiting. Before home discharge, the incidence of PONV, need for rescue antiemetics, quality or oral intake, and analgesic requirements did not differ between groups. However, during the 24 h after discharge, more patients in the control group experienced PONV (62% vs 24% in the steroid group) and complained of poor oral intake. Additionally, more children in the control group (8% vs 0% in the steroid group) returned to the hospital for the management of PONV and/or poor oral intake. The preoperative administration of dexamethasone significantly decreased the incidence of PONV over the 24 h after home discharge in these children., Implications: In this double blind, placebo-controlled study, we examined the efficacy of a single large dose (1 mg/kg; maximal dose 25 mg) of preoperative dexamethasone on posttonsillectomy postoperative nausea and vomiting (PONV) in children 2-12 yr of age undergoing tonsillectomy. Compared with placebo, dexamethasone significantly decreased the incidence of PONV in the 24 h after discharge, improved oral intake, decreased the frequency of parental phone calls, and resulted in no hospital returns for the management of PONV and/or poor oral intake.

Otitis media with effusion (OME) is one of the most frequent pediatric diagnoses and is also one of the most common indications for medical or surgical intervention in this age group. Pneumatic otoscopy is the standard for physical diagnosis of a middle ear effusion. We report on our experience with a validation program for otolaryngology-head and neck surgery residents in the use of pneumatic otoscopy to diagnose OME. Four PGY 2 residents sequentially completed a 4 month clinical and didactic training program in pneumatic otoscopy. The trainee sequentially performs pneumatic otoscopy, otomicroscopy, and myringotomy on each patient scheduled for a myringotomy and tube placement the morning of surgery. After each task the trainee is required to state if an effusion is present or not, and the accuracy of the diagnosis is immediately reinforced at the time of myringotomy. The trainee's sensitivity and specificity in diagnosing OME is then calculated for the first and second half of the study period. The trainee is validated in pneumatic otoscopy if the sensitivity is > 80% and > 70% respectively, and the trainee is validated in otomicroscopy if the sensitivity and specificity is > 90% and > 80% respectively. Four residents completed the protocol, and a total of 275 ears were examined. Four residents were validated in pneumatic otoscopy, and three residents were validated in otomicroscopy. We conclude that this protocol allows for accurate documentation of the resident's skill progression and enhances resident education.

The congenital tracheal cartilaginous sleeve (TCS) results from a vertical fusion of the tracheal cartilages. This rare malformation is usually associated with one of the craniosynostosis syndromes, such as Crouzon's disease, Pfeiffer's syndrome, or Goldenhar's syndrome. Three new cases of TCS are reported, two with autopsy findings including the histopathology of horizontal tracheal sections. Salient features of the clinical presentation, diagnostic evaluation, endoscopic findings, histopathology, treatment, and prognosis for TCS are summarized from the perspective of the otolaryngologist. In addition, the literature is reviewed, and previously reported cases are discussed. Although infants with TCS often have multiple abnormalities, this tracheal malformation is not incompatible with life. Since multiple lesions of the larynx and trachea may be present, endoscopic evaluation is recommended for infants with TCS who experience airway distress. A smooth trachea lacking the normal ridges of tracheal arches suggests the diagnosis of TCS. With early recognition and appropriate management (including tracheotomy, if necessary, and aggressive management of pulmonary hygiene), patients may survive into childhood.

Discharge planning for a child undergoing a tracheotomy is a complex process. In 1989, a multidisciplinary team at Children's Hospital of Michigan developed specific discharge criteria in a checklist format to address all facets of home care for these patients. We present and discuss the checklist. A survey of user satisfaction with the checklist demonstrated that 80% of parents and care-givers felt well-prepared by this format at the time their child was discharged from the hospital with a new tracheotomy. We conclude that the protocol allows for comprehensive and efficient discharge teaching of parents and care-givers for children with new tracheotomies.

Contemporary pediatric rigid bronchoscopy reflects the culmination of years of work by prominent endoscopists aided by technical developments in optical physics and refinements in optical lens manufacturing. Improved neonatal and pediatric care has allowed survival of premature infants, many with bronchopulmonary diseases. Rigid bronchoscopy in these infants is demanding and has necessitated the development of miniaturized telescopic bronchoscopes. This study documents airway pressures through bronchoscopes with and without endoscopic telescopes, analyzes and quantitates optical resolution, discusses the trade-offs between these instruments in airway resistance and optical resolution, and makes recommendations regarding which combinations of endoscopes and bronchoscopes provide the best resistance and resolution profiles. We conclude that the size 1.9-mm endoscopic telescope provides the most favorable resistance and resolution profile for the size 2.5 to 3.0 bronchoscopes, the 2.8-mm telescope is ideal for the 3.5 bronchoscope, and the 4.0-mm telescope works best with the 4.0 and larger bronchoscopes. Furthermore, optical forceps and side-channel forceps used during bronchial foreign body removal cause little change in airway resistance.

Sneezing or sternutation is usually the physiologic response to nasal irritation. The reflex follows a very complicated pathway requiring coordinated communication between the trigeminal and nervous terminalis afferent impulses as well as from glottic and inspiratory muscles in the efferent limb. When the reflex pathway is unbalanced, sneezing can increase in frequency and severity to the extent that some patients become disabled. We present the clinical examination, differential diagnosis, and treatment modalities for the case of an adolescent male who experienced debilitating intractable sneezing for more than one year. As for many of the patients described with this elusive diagnosis, our patient appears to have a functional etiology.

The presentation to the Department of Pediatric Otolaryngology at the Children's Hospital of Michigan of a series of patients with sensorineural hearing loss and enlargement of the vestibular aqueduct prompted exploratory tympanotomy in three patients (two unilateral and one bilateral), for a total of four ears. These explorations were prompted by progression and/or fluctuation of hearing levels. The discovery of abnormal round windows in all four ears with a post-traumatic fistula present in one ear suggested the presence of a new association. A previously undescribed association of an enlarged vestibular aqueduct, sensorineural hearing loss and round window abnormality with potential fistula formation was identified. A review of the anatomy and physiology, literature review, and a prospective analysis with discussion of eight patients with enlarged vestibular aqueduct syndrome evaluated and treated at Children's Hospital of Michigan, is presented. We conclude that all children with sensorineural hearing loss should undergo extensive evaluation to determine etiology, including radiographic studies of the temporal bone. Further, the presence of an enlarged vestibular aqueduct should prompt the otolaryngologist to consider the presence of a round window abnormality and the potential for predisposition to perilymph fistula.

In the past, various tracheotomy incisions have been used at the Children's Hospital of Michigan with the occurrence of complications related to accidental decannulation and immediate recannulation. Since that time the inferior based tracheal cartilage flap has been used to minimize early complications. A retrospective study of 126 pediatric tracheotomies performed at the Children's Hospital of Michigan from June 1986 to January 1991 was reviewed. Only tracheotomies performed by a staff otolaryngologist utilizing the inferior based tracheal cartilage flaps were reviewed. This study includes patients with a 6 month to 5 year follow up. The early complication rate was 4%, while the late was 50%. Stomal granulation tissue was comparatively increased in this series of patients but did not hinder decannulation. We consider the use of the inferior based tracheal cartilage flap in the pediatric population a safe and effective technique without increasing the morbidity of long-term tracheotomy.

Submandibular duct diversion is a common procedure for refractory sialorrhea in children. The procedure reroutes Wharton's ducts from the floor of the mouth to the tongue base. As the majority of saliva in the resting state is produced by the submandibular glands, rerouting markedly decreases sialorrhea. However, the procedure has been criticized in that diversion may cause fibrosis and stricture of the ducts. The gland would atrophy, and the physiologic functions of saliva would be lost. Glandular function of six patients with cerebral palsy (mean age, 14.7 years) was evaluated by technetium scanning (mean time after surgery, 43 months). Four patients had normal bilateral function; two patients had no function in one gland but normal function in the contralateral gland. We conclude that bilateral submandibular duct diversion maintains long-term function in at least one gland.

A retrospective review was conducted of all patients undergoing CO2 laser surgery by members of the Department of Otolaryngology-Head and Neck Surgery at Northwestern University Medical School from January 1, 1980 through December 31, 1981; 204 cases were identified and all are included in this report. Early in our department's experience with laser surgery, an endotracheal tube fire occurred. This incident precipitated a departmental review of complications associated with the use of the CO2 laser and resulted in the formulation of a laser safety protocol. All patients in this group were treated under the directives of this protocol; the operative complication rate was low. This retrospective analysis of complications associated with the use of the CO2 laser under a strictly applied protocol demonstrates the relative safety associated with judicious use of this instrument.

A prospective study utilizing a small, portable A-Mode ultrasound apparatus (Sinus-V 2500 Radionics Medical) was undertaken to screen children with signs and symptoms of sinusitis. Fifty-three children (age 2-16 years) were tested both by ultrasound and compared to standard radiographs of the paranasal sinuses. The sensitivity of the ultrasound to evaluate small, developing paranasal sinuses in children was low (22%). Sinus pathology, particularly mucosal thickening, was difficult to confirm. However, even opacified sinuses were only detectable in 58% of the time. Therefore, portable ultrasound devices to detect sinus disease in children, have limited usefulness for this particular population.

Nearly one in ten Americans has some degree of hearing loss. The primary care physician is frequently the first to examine patients with hearing and balance disorders. Examination begins with a thorough history and examination and may also include specific tests performed in the office. In many cases, the primary care physician can diagnose and treat disorders successfully. In other cases, referral to a specialist is necessary.

Patients in sickle cell crisis may complain of unilateral or bilateral hearing loss which is typically a mild to moderate high-frequency sensorineural hearing loss in the affected ear(s). Auditory acuity can return to precrisis levels. A literature review suggests that the etiology is cochlear ischemia. A review of the literature, case study, and discussion will be presented.

The efficacy of a new third-generation cephalosporin, cefixime, in the treatment of acute otitis media resulting from infection with ampicillin-resistant, beta-lactamase-producing nontypable Haemophilus influenzae, was evaluated using the chinchilla animal model. The results showed that cefixime, administered in moderately low doses (8 mg/kg of body weight, two times per day), readily penetrated the chinchilla middle ear and rapidly sterilized the effusion. The data also suggest that the effusions were resolved more quickly in the cefixime-treated group compared with a group of animals treated with ampicillin or an untreated control group. No adverse side effects were noted in the cefixime-treated animals. The results of this study warrant the testing of cefixime for acute otitis media in the clinical setting.